Information Collection

IC5b: National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results

IC 250710 under ICR 202112-2126-001 · OMB 2126-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0006 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MCSA-5850 IC5b: National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results	Form
MCSA-5850 CMV Driver Medical Examination Results Form MCSA-5850 Form 1-8-2021 exp 508.pdf	Form
MCSA-5850 CMV Driver Medical Examination Results Form MCSA-5850 Form 1-8-2021 exp 508.pdf	Form

IC Title:

IC5b: National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 391.41

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MCSA-5850	CMV Driver Medical Examination Results Form	MCSA-5850 Form 1-8-2021 exp 508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 65,535

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	9,708,850	9,708,850
Annual IC Time Burden (Hours)	197,448	197,448
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.